Skip to main content

Advertisement

SpringerLink
Log in

Patient-specific instrument for unicompartmental knee arthroplasty does not reduce the outliers in alignment or improve postoperative function: a meta-analysis and systematic review

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Unsatisfactory alignment in unicompartmental knee arthroplasty (UKA) is one potential cause of postoperative failure. Patient-specific instruments (PSIs) are designed to improve the alignment of the prostheses, but the effect of PSIs on the alignment or clinical outcome is controversial and lacks validated evidence. We conducted a meta-analysis and systematic review to determine the effect of PSIs on UKA outcomes for the first time.

Materials and methods

A systematic literature search in MEDLINE, EMBASE, CNKI (Chinese database) and Cochrane Central Register of Controlled Trials (up to June 2019) was performed to collect studies that compared PSIs with conventional instruments. Two reviewers independently screened all the records on the basis of inclusion and exclusion criteria. Quality assessments with Cochrane’s quality assessment tool or Newcastle–Ottawa scale (NOS) were conducted, the data were extracted, and statistical analyses were completed.

Results

Ten studies with 444 knees were included. The meta-analysis confirmed that PSIs contributed to reduced errors in the alignment of the femoral compartment in the sagittal plane (mean difference = − 2.53, CI [− 3.14, − 1.99], P < 0.01) and the tibial compartment in both the coronal (mean difference = − 0.97, CI [− 1.44, − 0.49], P < 0.01) and the sagittal plane (mean difference = − 1.29, CI [− 1.81, − 0.76], P < 0.01). One study supported that PSIs reduced outliers in inexperienced surgeons; however, all studies investigating PSIs among experienced surgeons suggested that PSIs cannot reduce the percentage of outliers. There was no significant difference in the postoperative score (mean difference = − 0.06, CI [− 0.36, 0.23], P = 0.68) or rate of complications (RR = 1.02, CI [0.15, 6.79], P = 0.99) between PSIs and conventional instruments.

Conclusion

The findings of this study suggest PSIs could not reduce the percentage of outliers in UKA patients for experts, and postoperative scores and complication rates are not improved by PSIs, compared with conventional instruments. Based on this meta-analysis and systematic review, no practical benefit to UKAs in experts was detected in PSIs. The findings of this study also suggest that PSIs improved alignment of UKA and might be beneficial to inexperienced surgeons, but it is still unclear whether this improvement is clinically significant and the evidence of inexperienced surgeons is limited. Therefore, more high-quality RCTs are need to be carried out in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Hansen EN, Ong KL, Lau E, Kurtz SM, Lonner JH (2019) Unicondylar knee arthroplasty has fewer complications but higher revision rates than total knee arthroplasty in a study of large United States databases. J Arthroplasty 34(8):1617–1625. https://doi.org/10.1016/j.arth.2019.04.004

    Article  PubMed  Google Scholar 

  2. Jones GG, Kotti M, Wiik AV, Collins R, Brevadt MJ, Strachan RK, Cobb JP (2016) Gait comparison of unicompartmental and total knee arthroplasties with healthy controls. The Bone Jt J 98-B(10 Supple B):16–21. https://doi.org/10.1302/0301-620X.98B10.BJJ.2016.0473.R1

    Article  CAS  Google Scholar 

  3. Liddle AD, Pandit H, Judge A, Murray DW (2015) Patient-reported outcomes after total and unicompartmental knee arthroplasty: a study of 14,076 matched patients from the National Joint Registry for England and Wales. The Bone Jt J 97B(6):793–801. https://doi.org/10.1302/0301-620X.97B6.35155

    Article  Google Scholar 

  4. Dagneaux L, Bourlez J, Degeorge B, Canovas F (2017) Return to sport after total or unicompartmental knee arthroplasty: an informative guide for residents to patients. EFORT Open Rev 2(12):496–501. https://doi.org/10.1302/2058-5241.2.170037

    Article  PubMed  PubMed Central  Google Scholar 

  5. Arirachakaran A, Choowit P, Putananon C, Muangsiri S, Kongtharvonskul J (2015) Is unicompartmental knee arthroplasty (UKA) superior to total knee arthroplasty (TKA)? A systematic review and meta-analysis of randomized controlled trial. Eur J Orthop Surg Traumatol 25(5):799–806. https://doi.org/10.1007/s00590-015-1610-9

    Article  PubMed  Google Scholar 

  6. Kleeblad LJ, van der List JP, Zuiderbaan HA, Pearle AD (2018) Larger range of motion and increased return to activity, but higher revision rates following unicompartmental versus total knee arthroplasty in patients under 65: a systematic review. Knee Surg Sports Traumatol Arthrosc 26(6):1811–1822. https://doi.org/10.1007/s00167-017-4817-y

    Article  PubMed  Google Scholar 

  7. Hernigou P, Deschamps G (2004) Alignment influences wear in the knee after medial unicompartmental arthroplasty. Clin Orthop Relat Res 423:161–165. https://doi.org/10.1097/01.blo.0000128285.90459.12

    Article  Google Scholar 

  8. Zhu GD, Guo WS, Zhang QD, Liu ZH, Cheng LM (2015) Finite element analysis of mobile-bearing unicompartmental knee arthroplasty: the influence of tibial component coronal alignment. Chin Med J 128(21):2873–2878. https://doi.org/10.4103/0366-6999.168044

    Article  PubMed  PubMed Central  Google Scholar 

  9. Jeschke E, Gehrke T, Gunster C, Hassenpflug J, Malzahn J, Niethard FU, Schrader P, Zacher J, Halder A (2016) Five-year survival of 20,946 unicondylar knee replacements and patient risk factors for failure: an analysis of german insurance data. J Bone Jt Surg Am 98(20):1691–1698. https://doi.org/10.2106/jbjs.15.01060

    Article  Google Scholar 

  10. Hernigou P, Deschamps G (2004) Posterior slope of the tibial implant and the outcome of unicompartmental knee arthroplasty. J B Jt Surg Am 86(3):506–511. https://doi.org/10.2106/00004623-200403000-00007

    Article  Google Scholar 

  11. Kang KT, Son J, Kwon SK, Kwon OR, Koh YG (2018) Preservation of femoral and tibial coronal alignment to improve biomechanical effects of medial unicompartment knee arthroplasty: computational study. Bio Med Mater Eng 29(5):651–664. https://doi.org/10.3233/bme-181015

    Article  CAS  Google Scholar 

  12. Barbadoro P, Ensini A, Leardini A, d'Amato M, Feliciangeli A, Timoncini A, Amadei F, Belvedere C, Giannini S (2014) Tibial component alignment and risk of loosening in unicompartmental knee arthroplasty: a radiographic and radiostereometric study. Knee Surg Sports Traumatol Arthrosc 22(12):3157–3162. https://doi.org/10.1007/s00167-014-3147-6

    Article  CAS  PubMed  Google Scholar 

  13. Dalton DM, Burke TP, Kelly EG, Curtin PD (2016) Quantitative analysis of technological innovation in knee arthroplasty: using patent and publication metrics to identify developments and trends. J Arthroplasty 31(6):1366–1372. https://doi.org/10.1016/j.arth.2015.12.031

    Article  PubMed  Google Scholar 

  14. Boyd JL, Kurtenbach CA, Sikka RS (2014) Patient-specific instrumentation and return to activities after unicondylar knee arthroplasty. Clin Sports Med 33(1):133–148. https://doi.org/10.1016/j.csm.2013.08.003

    Article  PubMed  Google Scholar 

  15. Jones GG, Clarke S, Jaere M, Cobb J (2018) 3D printing and unicompartmental knee arthroplasty. Efort Open Rev 3(5):248–253. https://doi.org/10.1302/2058-5241.3.180001

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hafez MA, Moholkar K (2017) Patient-specific instruments: advantages and pitfalls. SICOT J 3:66. https://doi.org/10.1051/sicotj/2017054

    Article  PubMed  PubMed Central  Google Scholar 

  17. Liddle AD, Pandit H, Judge A, Murray DW (2016) Effect of surgical caseload on revision rate following total and unicompartmental knee replacement. J Bone Jt Surg Am 98(1):1–8. https://doi.org/10.2106/JBJS.N.00487

    Article  Google Scholar 

  18. Hamilton WG, Ammeen D, Engh CA Jr, Engh GA (2010) Learning curve with minimally invasive unicompartmental knee arthroplasty. J Arthroplasty 25(5):735–740. https://doi.org/10.1016/j.arth.2009.05.011

    Article  PubMed  Google Scholar 

  19. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535. https://doi.org/10.1136/bmj.b2535

    Article  PubMed  PubMed Central  Google Scholar 

  20. Higgins JPT, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JAC, Grp CBM, Grp CSM (2011) The cochrane collaboration's tool for assessing risk of bias in randomised trials. BMJ 343:D5928. https://doi.org/10.1136/Bmj.D5928

    Article  PubMed  PubMed Central  Google Scholar 

  21. Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605. https://doi.org/10.1007/s10654-010-9491-z

    Article  PubMed  Google Scholar 

  22. Bonett DG (2009) Meta-analytic interval estimation for standardized and unstandardized mean differences. Psychol Methods 14(3):225–238. https://doi.org/10.1037/a0016619

    Article  PubMed  Google Scholar 

  23. Alvand A, Khan T, Jenkins C, Rees JL, Jackson WF, Dodd CAF, Murray DW, Price AJ (2018) The impact of patient-specific instrumentation on unicompartmental knee arthroplasty: a prospective randomised controlled study. Knee Surg Sports Traumatol Arthrosc 26(6):1662–1670

    Article  PubMed  Google Scholar 

  24. Cai JF, Ma M, Zeng W, Luo SL, Yuan F, Zhou W, Yang S, Wang H, Yin F (2017) Accuracy of individualized custom femoral cutting guides in unicompartmental knee arthroplasty of femoral specimens. Chin J Anat Clin 22(5):373–377. https://doi.org/10.3760/cma.j.issn.2095-7041.2017.05.005[Chinese]

    Article  Google Scholar 

  25. Fan ZQ, Nie Y, Fu DL, Liu SY, Li L, Li YF, Zhang F (2018) Cinical application of 3D printing plate in unicompartmental knee arthroplasty. Chin J Gene Prac 16(7):1085–1087 [Chinese]

    Google Scholar 

  26. Jaffry Z, Masjedi M, Clarke S, Harris S, Karia M, Andrews B, Cobb J (2014) Unicompartmental knee arthroplasties: robot vs. patient specific instrumentation. Knee 21(2):428–434

    Article  PubMed  Google Scholar 

  27. Jones GG, Logishetty K, Clarke S, Collins R, Jaere M, Harris S, Cobb JP (2018) Do patient-specific instruments (PSI) for UKA allow non-expert surgeons to achieve the same saw cut accuracy as expert surgeons? Arch Orthop Trauma Surg 138(11):1601–1608

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kerens B, Schotanus MG, Boonen B, Kort NP (2015) No radiographic difference between patient-specific guiding and conventional Oxford UKA surgery. Knee Surg Sports Traumatol Arthrosc 23(5):1324–1329. https://doi.org/10.1007/s00167-014-2849-0

    Article  PubMed  Google Scholar 

  29. Li XW, Ding J, Gan YD (2018) Application of individualized navigation template in the location of femeral and tibial prothesis in Oxford single condylar replacement. Chin J Orthop 38(3):172–178. https://doi.org/10.3760/cma.j.issn.0253-2352.2018.03.007[Chinese]

    Article  CAS  Google Scholar 

  30. Ng CTJ, Newman S, Harris S, Clarke S, Cobb J (2017) Patient-specific instrumentation improves alignment of lateral unicompartmental knee replacements by novice surgeons. Int Orthop 41(7):1379–1385

    Article  PubMed  Google Scholar 

  31. Ollivier M, Parratte S, Lunebourg A, Viehweger E, Argenson JN (2016) The John insall award: no functional benefit after unicompartmental knee arthroplasty performed with patient-specific instrumentation: a randomized trial. Clin Orthop Relat Res 474(1):60–68

    Article  PubMed  Google Scholar 

  32. Sanz-Ruiz P, Matas-Diez JA, Carbo-Laso E, Perez-Mananes R, Vaquero-Martin J (2019) Patient-Specific instrument can improve functional and radiographic results during learning curve for Oxford unicompartmental knee arthroplasty. J Knee Surg 32(2):180–185

    Article  PubMed  Google Scholar 

  33. Heyse TJ, Lipman JD, Imhauser CW, Tucker SM, Rajak Y, Westrich GH (2014) Accuracy of individualized custom tibial cutting guides in UKA. HSS J 10(3):260–265

    Article  PubMed  PubMed Central  Google Scholar 

  34. Leenders AM, Schotanus MGM (2018) A high rate of tibial plateau fractures after early experience with patient-specific instrumentation for unicompartmental knee arthroplasties. Knee Surg Sports Traumatol Arthrosc 26(11):3491–3498. https://doi.org/10.1007/s00167-018-4956-9

    Article  CAS  PubMed  Google Scholar 

  35. Flury A, Hasler J, Dimitriou D, Antoniadis A, Finsterwald M, Helmy N (2019) Midterm clinical and radiographic outcomes of 115 consecutive patient-specific unicompartmental knee arthroplasties. Knee 26:889–896

    Article  PubMed  Google Scholar 

  36. Seeber GH, Kolbow K, Maus U, Kluge A, Lazovic D (2016) Medial unicompartmental knee arthroplasty using patient-specific instrumentation—accuracy of preoperative planning, time saving and cost efficiency. Zeitschrift fur Orthopadie Unfallchirurgie 154(3):287–293

    Article  CAS  Google Scholar 

  37. Liow MH, Tsai TY, Dimitriou D, Li G, Kwon YM (2016) Does 3-Dimensional in vivo component rotation affect clinical outcomes in unicompartmental knee arthroplasty? J Arthroplasty 31(10):2167–2172. https://doi.org/10.1016/j.arth.2016.03.003

    Article  PubMed  Google Scholar 

  38. Iriberri I, Aragon JF (2014) Alignment of the tibial component of the unicompartmental knee arthroplasty, assessed in the axial view by CT scan: does it influence the outcome? Knee 21(6):1269–1274. https://doi.org/10.1016/j.knee.2014.06.008

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was funded by the National Natural Science Foundation of China Program (Nos. 81601936, 81672219), the Science and Technology Department of Sichuan Province (No. 2018HH0141), the Health Department of Sichuan Province (No. 18ZD016) and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University (No. Z20191008).

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan, People’s Republic of China

    Mingyang Li, Yi Zeng, Yuangang Wu, Yuan Liu, Wenxing Wei, Limin Wu & Bin Shen

  2. State Key Laboratory of Biotherapy, Collaborative Innovation Center for Biotherapy, Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, West China Hospital, Sichuan University, Chengdu, China

    Bo-qiang Peng

  3. Department of Nephrology, The People’s Hospital of Dazu District, Chongqing, China

    Jiayi Li

Authors
  1. Mingyang Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yi Zeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuangang Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wenxing Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Limin Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Bo-qiang Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jiayi Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bin Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bin Shen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, M., Zeng, Y., Wu, Y. et al. Patient-specific instrument for unicompartmental knee arthroplasty does not reduce the outliers in alignment or improve postoperative function: a meta-analysis and systematic review. Arch Orthop Trauma Surg 140, 1097–1107 (2020). https://doi.org/10.1007/s00402-020-03429-z

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-020-03429-z

Keywords

Search

Navigation